BACKGROUND: Long-acting injectable (LAI) antipsychotics (APs) can improve adherence and patient outcomes among patients with schizophrenia, though widespread adoption varies across the United States (US). This analysis aims to describe variations in AP utilization rates across US geographies and evaluate the association between LAI utilization rates and healthcare costs.
METHODS: Adult beneficiaries with ‚≥2 schizophrenia diagnoses, continuous enrollment, and consistent geographical data in each calendar year were identified from CMS Medicaid Analytic eXtract (MAX) data from 2012-2014 for all available states. Using a cross-sectional study design, AP utilization rates by type and total healthcare spending were reported by state and year. A generalized estimating equation (GEE) model was used to evaluate the association between LAI utilization rates and total healthcare spending at the 3-digit ZIP code level, adjusting for age, male, race, capitated and/or dual Medicaid/Medicare coverage, year, and Quan-Charlson Comorbidity index.
RESULTS: A total of 1,038,770 patients with schizophrenia met the inclusion criteria. AP utilization rates ranged from 15.8% to 82.2% across states, whereas LAI utilization rates ranged from 4.1% to 29.1% only. Per patient per year (PPPY) total healthcare spending ranged from $11,330 to $47,068. Adjusted analyses indicated that a 5 percentage point higher LAI utilization rate in a given 3-digit ZIP code region was associated with a $1,614 lower PPPY total healthcare spending (P < 0.001).
CONCLUSIONS: This study indicates that AP and LAI utilization rates among Medicaid beneficiaries with schizophrenia vary considerably across states. Also, higher LAI utilization rate was significantly associated with total healthcare savings PPPY.